Abstract
Clinical History:
A 19-year-old male presented with bilateral undescended testes. Reported voice changes and axillary hair growth at age 13, with limited penile growth and absent morning erections. Denied prior surgical history, prematurity, trauma, or torsion.
Physical Exam:
Tanner stage 3 with a buried penis, 5 cm length, small symmetric rugated scrotum, and nonpalpable testes bilaterally.
Diagnosis:
Pelvic ultrasound identified inguinal right (1.8 × 1.1 × 1.0 cm), and inguinal left (1.9 × 1.1 × 1.3 cm) testes, possible left dysmorphic without evident mass or calcification. Labs: FSH 0.3, LH < 0.1, testosterone 32 ng/dL (hypogonadotropic hypogonadism). Semen analysis: azoospermia.
Intervention:
Despite achieving maximal mobilization through an open approach at time of biopsy, the ∼1cm left testis remained near the external inguinal ring and under significant tension. The case proceeded with intra-abdominal mobilization using the Da Vinci Xi robotic system using a supraumbilical camera port, and two ports in the midaxillary line at the level of the umbilicus. There were bilateral closed rings with a small vas bilaterally. Retroperitoneal mobilization of the peritoneum is demonstrated in the video and was completed bilaterally (EBL 2 mL, robotic case time 52 minutes), with successful completion of a single stage bilateral orchidopexy.
Follow-Up/Outcomes:
Same day discharge without perioperative complications. Pathology: Sertoli only cells. Postoperative scrotal ultrasound revealed stable testicular volume and normal blood flow. One-year follow-up: palpable bilateral small testes in a dependent scrotal position on testosterone supplementation.
The authors have no relevant or material financial interests that relate to the research described in this article and video production
. The following articles have provided background in robotic orchiopexy, and were reviewed by the authors in creation of this video. 1 -4
Patient Consent Statement:
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
Music Copyright:
Music featured in the video was obtained as sound effects provided from Apple’s iMovie application, and thus no copyright infringements have occurred as part of the production of this video.
No competing financial interests exist
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Runtime of video: 4 mins 54 secs